ICU ROTATION FOR CA1s

[drofgas]

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Hello there,
I wanted to ask you if in your program(s) CA1s (on their first ICU rotation) go alone to codes and/or floor intubations, or are they going with an attending and/or CA2.
I would really appreciate your answers.
Thank you!
Happy Sunday before call day.
A.

 

[coprolalia]

Well, my personal opinion is that you should know how to run a code as a CA1/PGY-2.

It depends on who shows up, though, based on your institution. If you don't know, I'd ask.

At my institution, I often show up to find 20 people in the room, half of whom are standing around looking clueless, 1/4 are trying to find stuff and running around like a chicken with their head cut off, and the other 1/4 are often the "medicine" staff who are deeply engrossed in a chart biopsy.

Usually, I arrive, go to the head of the bed, stick the tube in, and then start telling people to actually do things. If an attending shows up sooner or later, they usually don't interfere.

So far, this system has seemed to work pretty good for me individually. The people that are "saveable" have been saved, and those who aren't haven't been. Either way, I'm not the one who made them "code", so I don't sweat it too much when I get there. I just do what needs to be done. And, try to keep composure among others in the room.

If you appear to be in charge, and you keep your cool, it's amazing how smoothly codes can go. If you lose your cool, it can be a disaster. That's the key thing to know about showing up at codes. If the room is out of control, take control. If everything is going smoothly, just fit in and ask how you can help while working to keep things flowing.

-copro

 

[rsgillmd]

Hello there,
I wanted to ask you if in your program(s) CA1s (on their first ICU rotation) go alone to codes and/or floor intubations, or are they going with an attending and/or CA2.
I would really appreciate your answers.
Thank you!
Happy Sunday before call day.
A.

At my program, the attendings will generally vote to credential CA1s to intubate independently on the floor beginning in January of their CA1 year.

In our program the resident covering PACU during the day carries the code pager. Another resident who is already credentialed has a secondary code pager in case there are two codes at the same time. The PACU attending single covers a room, so he/she is available for backup as needed.

This allows the resident doing an ICU rotation to remain in the ICU.

 

[periopdoc]

Here is how it works at UW.

The code resident and the attending in charge both carry a code pager. The attendings generally know whether it is a senior or junior resident carrying the resident pager.

If a code is called and intubation is done without any induction agents or paralytics, any resident is allowed to intubate whether the attending is present or not.

If it is any other type of intubation (requiring induction/ paralysis) the attending must be present before proceeding. This is so that we can bill for the procedure and the program is covered from a liability perspective. Now if it is a senior resident, the attending usually watches from across the room or does scheduling stuff. If it is a junior resident, the attending is more actively involved.

Often times there will be a senior resident and a junior resident present. In this case the majority of the attendings will step back and allow the senior resident to assume a supervisory role and only step in if the situation deteriorates.

Of course some of my biggest confidence builders were the urgent ICU intubations I did solo as a CA-1 at our county hospital prior to the current policy being enacted.

Hope that helps

- pod

 

[proman]

This is what we do. Our M&Ms associated with floor intubations have plummetted. MGH recently published something with similar results. Also helps to have attending back up when intubation is not indicated but the medicine or surgery services think it is.